Hyp-Pit (Exam 1) Flashcards
GH deficiency is treated with?
Somatotropin
Laron syndrome is treated with?
Mecasermin (IGF-1)
Treatment for acromegaly?
Octreotide (IR-ER), Lanreotide (ER), Cabergoline, Pegvisomant
Treatment for neurogenic diabetes insipidus?
Desmopressin
Treatment for nephrogenic diabetes insipidus?
Fluids, thiazides, and NSAIDs
Treatment for SAIDH?
Restrict free H2O, NaCl, Tolvaptan, Canivaptan
Thy hypothalamus releases ______ to stimulate GH release from the ant. pituitary.
GHRF
What hormone released by the hypothalamus causes negative feedback for GH release?
Somatostatin
GH is metabolized to what in the liver?
IGF-1
IGF-1 preforms positive feedback where?
On somatostatin release from the hypothalamus.
IGF-1 preforms negative feedback where?
GH release from ant. pituitary.
GH preforms negative feedback where?
GHRH release from hypothalamus.
Function of both GH and IGF-1 is?
Growth of peripheral tissue.
Growth hormone is also called?
Somatotropin
List some things that increase release of GH.
GHRH, exercise, hypoglycemia, dopamine, arginine, ghrelin.
List some things that decrease GH release.
somatostatin, dopamine agonists.
What is the route of administration for somatotropin?
SC
How long after injection do somatotropin levels peak? How long is it active after injection?
Peak 2-4 hours
Active levels persist 36 hours
What is the treatment for a child with GH deficiency?
SC injection of somatotropin daily at bedtime.
List some of the brand names for somatotropin injections.
Humatrope, serostim, genotropin, nutropin, norditripin.
What is more common, GH deficiency or GH insensitive deficiency?
GH deficiency
GH insensitive deficiency is also known as?
Laron syndrome
Treatment for Laron syndrome?
Recombinant IGF-1 (mecasermin)
What side effect of mecasermin is concerning?
What can you do to minimize this side effect?
Hypoglycemia
Increase carb intake prior to SC injection.
Uses of GH in adults?
Pituitary tumor, turner’s syndrome, prader willi syndrome, chronic renal insufficiency, wasting or cachexia in AIDS patients, short bowel syndrome.
T/F? Off label use of GH is illegal.
True
Adverse reactions to GH?
Insulin resistance, idiopathic intracranial hypertension, pancreatitis, gynecomastia, nevus growth.
GH misuse in athletes can cause?
Acromegaly, arthropathy, extremity enlargement, visceromegaly.
Somatostatin is also known as?
SST, SRIH (somatotropin releaseing inhibiting hormone)
What medication are somatostatin analogs?
Octreotide and Lanreotide
Routes of administration for somatostatin analogs?
Octreotide - SQ every 6-12 hours
Lanreotide - SQ every 4 weeks
Octreotide LAR - IM every 4 weeks
Preferred treatment for excess of growth hormone?
Surgical resection when possible.
When surgical resection is not possible, what is the preferred therapy for excess growth hormone?
Lanreotide is preferred after response seen to SC octreotide
Second line treatment for excess GH?
Dopamine agonists - Cabergoline
OR
GH receptor antagonist - Pegvisomant
What are non-pituitary uses of somatostatin analogs?
Constriction of vascular smooth muscle for treatment of esophageal varices and GI hemorrhage
Adverse reactions to somatostatin analogs?
Hyperglycemia, abd cramps, loose stools, sinus brady, and conduction disturbances
Prolactin is released from?
Ant pituitary
Prolactin release is inhibited by?
Dopamine
Main stimulus for prolactin release?
Suckling - causes 10-100 fold increase within 30 minutes
Prolactin release is under inhibitory control by hypothalamic dopamine at ___ receptors.
D2
Prolactin stimulates?
Milk production
Prolactin inhibits?
Gonadotropin (FSH/LH) release and ovarian response to those hormones.
Results in lack of ovulation during breastfeeding
Treatment for hypoprolactinemia?
No commercially available preperation
Treatment for hyperprolactinemia?
Dopamine agonists
Preferred dopamine agonist for hyperprolactinemia?
Cabergoline - More selective for D2 receptor and more effective in reducing prolactin secretion.
Second line dopamine agonist for hyperprolactinemia?
Bromocriptine
ADH is also known as?
Vasopressin
ADH is released from?
Post pituitary
The main stimulus for release of ADH is?
Rising blood osmolarity
ADH release is inhibited by?
Ethanol
Renal actions of ADH are mediated by?
V2 receptors (GCPRs)
Mechanism of action of ADH to decrease water excretion?
Increase rate of insertion of aquaporins into luminal membrane
What are non-renal V2 actions?
Increased release of coagulation factor VIII and von Willebrand’s factor
Treatment of choice for neurogenic diabetes insipidus?
Desmopressin
Routes of administration for desmopressin?
SC, IV, Nasally, Orally
Nephrogenic diabetes insipidus can be congenital due to aquaporin mutations, or caused by drugs. Name 2 drugs that can cause nephrogenic diabetes insipidus.
Lithium
Demeclocycline
Treatment of nephrogenic diabetes insipidus?
Fluids
Thiazide diuretics
NSAIDs (indomethacin)
Diabetes insipidus is post. pituitary _____ (hypo/hyperfunction).
SAIDH is post. pituitary ______(hypo/hyperfunction).
hypofunction
hyperfunction
What drug classes are most commonly implicated in SAIDH?
SSRIs, haldoperidol, TCAs
Sunfonylureas (chlorporpamide)
Vinca alkaloids (chemo)
Methylenedioxymethamphetamine (MDMA)
Treatment of SAIDH?
Restriction of free water intake
NaCl administration
Demeclocyline or lithium
SAIDH causes hyponatremia. How is this treated?
V2 receptor antagonists - Tolvaptan (oral), Conivaptan (IV)
Rapid correction of hyponatremia should be avoided to reduce risk of?
Cerebellar pontine myelinolysis
Vasopressin is used for treatment of?
Severe septic shock
